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Moody Chisholm Speaks at Healthcare Policy Conference

The Florida Times-Union

Will Weatherford, the speaker of the Florida House of Representatives, said at a Healthcare Policy Conference at Jacksonville University Wednesday that he would like to see “everybody have insurance.”

“I’m not proud we have so many uninsured citizens,” said Weatherford, a JU graduate, during a conference organized by JU’s Public Policy Institute.

But he said expanding Medicaid in Florida is not the way to fix the problem.

However, a number of speakers, including Florida Blue’s Pat Geraghty, Haskell CEO Steve Halverson and St. Vincent’s HealthCare CEO Moody Chisholm said it would be a terrible mistake to refuse to accept $51 billion in federal money while uninsured people continue to receive health care and those costs are absorbed by the hospitals and ultimately passed along to the insured.

With 25 percent of its residents without health insurance, Florida ranks second in the nation behind Texas in the percentage of uninsured. The Affordable Care Act, also known as Obamacare, contained a provision that would have expanded Medicaid coverage to an additional 1.1 million Florida residents. But the U.S. Supreme Court gave states the option to opt out of Medicaid expansion. That’s what Florida has done so far.

Weatherford said he opposes Medicaid expansion because he doesn’t trust the federal government’s pledge to underwrite the cost of Medicaid expansion for the first three years and then continue to fund as much as 90 percent of the expansion in succeeding years. He also said that the provision of the Affordable Care Act that prevents people whose income is below the federal poverty level from purchasing health insurance through health-care exchanges has the effect of “creating two Americas.”

Florida Senate President Don Gaetz called Medicaid’s growth “metastatic.” He said that over the last decade the cost of Medicaid to the state has increased from $14 billion in 2004 to $23 billion this year, constituting 31 percent of the state budget.

But regardless of whether the uninsured get or don’t get coverage through expanded Medicaid, the reality is that “we are paying for them,” said Geraghty, CEO of Florida Blue.

Hospitals are required to treat people who arrive in their emergency rooms whether those people have coverage or not.

“The question is how do we want to pay for them,” Geraghty said.

Without the $51 billion the federal government would provide over the next decade if Medicaid expanded, Florida hospitals, particularly safety net hospitals like UF Health Jacksonville (formerly Shands Jacksonville), will be hard hit financially, members of a panel of five CEOs of Jacksonville hospitals said.

Russ Armistead, CEO of UF Health Jacksonville, called his hospital “the canary in the mine shaft.”

With 51 percent of the hospital’s patients either Medicaid patients or uninsured patients and only 11 percent covered by commercial insurance, “we’ll be the first to go bankrupt,” Armistead said.

Gaetz said he wasn’t categorically opposed to accepting the $51 billion to expand health coverage in Florida. In fact, he said, he wrote a letter to Kathleen Sibelius, U.S. secretary of Health and Human Services, asking that the federal government “give states flexibility to innovate solutions” using the federal money. The response, he said, was “take it or leave it.”

Meanwhile, a potential crisis for the Affordable Care Act could loom if the healthy young people whose health-care premiums are supposed to underwrite the premiums of older, less healthy people don’t sign up, said Weatherford, who called the law well-intentioned but poorly executed. There is a penalty built into the law for those who refuse to participate. But that penalty in the first year is only $95, rising to $695 in 2016, and it can only be collected by holding back some of that person’s tax refund.

While much of the focus of the conference was on Medicaid expansion and the financial crisis hospitals will face without it, Geraghty and Ford Koles, executive director of The Advisory Board Company, which studies trends in the health-care insurance industry, said other fundamental changes are coming to the American health-care system.

Fee for service may soon be replaced by pay per performance, making it incumbent on providers to prevent excessive hospitalizations. Employers are beginning to contract directly with providers. Company’s like Walgreens are entering the primary care business. Websites are popping up that allow consumers to compare the prices various providers charge for their services.

“We’ve got a more engaged consumer in the marketplace,” Geraghty said.